Archive for March 2009
Let’s Not Forget the “Performance” in PI CME
The AMA guidelines on Performance Improvement CME require that physicians assess their current practice using identified evidence based performance measures. A good start. After the assessment they know where they stand on the measures compared to their peers and national standards. Then they are encouraged to do an intervention based on the performance measures assessed in their practice. But what? How will they know what practice behaviors to change that will reduce the variation in the performance in their practice compared to national standards? What performance behaviors have kept them from meeting the expectations of the standard? Knowing this gets to the heart of PI CME.
Should we encourage the physician participating in a PI CME initiative to engage in a dialogue in the practice setting around what is the right thing to do to meet expectations? Seems to me that might require gaining a deep understanding of what is actually going on in the practice. That understanding will help the physician comprehend the real nature of why the performance in their practice is not meeting expectations. They can analyze alternative causes and develop an understanding on how to “work” the practice to select reasonable countermeasures to improve the situation. Permanent change is not likely to come from a physician authority based management model. Permanent change will come from a “responsibility based” management model in which every person involved in any aspect of the care being examined understands how their effort effects the current outcomes and how any proposed countermeasures will impact the desired outcomes.
Simply taking recommendations from guidelines and trying to apply them in practice, as important as that is, without a fact based understanding how the context in which the care is being provided impacts the care, may not result in lasting performance change. As CME providers are we ready to take this one on? We have a great opportunity to facilitate a “Culture of Change” in practices engaged in PI CME, We need to help physicians understand how to look at performance, how to understand why they are getting outcomes less then what they want, and how to “work” the practice to the place where desired outcomes are the new standard in that setting.
Do we have the skill set to do that or do we need to develop that skill set? Not a rhetorical question.
